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Practicing 'Extreme Medicine,' From Deep Sea To Outer Space

Dr. Kevin Fong explores how humans survive extremes of heat, cold, outer space and deep sea. He compares the exploration of medicine with the "explorers of the 20th century and every age before them."

42:10

Other segments from the episode on April 10, 2015

Fresh Air with Terry Gross, April 10, 2015: Interview with Dr. Kevin Fong; Review of the film 'Clouds of Sils Maria'.

Transcript

April 10, 2015

Guest: Kevin Fong

DAVID BIANCULLI, HOST: This is FRESH AIR. I'm David Bianculli, editor of the website TV Worth Watching, in for Terry Gross. Our understanding of how our bodies work and the nature of the boundary between life and death is being challenged by avant-garde medicine, writes our guest Dr. Kevin Fong. In his book "Extreme Medicine," Fong explains what medical science has learned about surviving extremes of heat, cold and trauma and how the body can cope with the extreme conditions of outer space and the deep sea. Dr. Fong is an anesthesiologist who is also trained in intensive care medicine. He's a co-founder of the Center for Altitude, Space and Extreme Environment Medicine at the University College London, where he's also a professor of physiology. He's the former chair of the U.K. Space Biomedical Advisory Committee. Terry spoke with him last year when his book was published. It's just come out in paperback.

(SOUNDBITE OF ARCHIVED BROADCAST)

TERRY GROSS, BYLINE: Dr. Kevin Fong, welcome to FRESH AIR. Let's start with space medicine. What are some of the things you can't do medically in zero gravity that doctors are used to doing on Earth?

KEVIN FONG: Well, you know, the thing is, and the thing I came to realize when I worked out with the guys at NASA, was that almost everything you take for granted in everyday medicine doesn't work there. You know, the first thing I do when I go and see a patient is I walk up to their bedside and say, hi, how are you? What seems to be the problem? And of course, even doing that, you can't do in space because you're floating, your patient's floating. So you have to manage that situation just for starters. So usually that involves Velcroing them to the floor of the vehicle and Velcroing yourself to them...

GROSS: (Laughter).

FONG: ...Or strapping yourself down near them. And then, you know, there's so much in medicine that depends upon gravity. You know, the drips that they stick into your arm to rehydrate you - you know, that's a gravity-dependent process. But all of the kits that you would unpack - you know, that stuff doesn't stay on the trays. You've got to find ways to pack that stuff - the drugs, the needles, the scalpels and all of that - so it doesn't end up floating around.

So just the basics need addressing, and then you've got to start getting into the nitty-gritty of what the space environment does to the human body and how that's going to create even greater challenge for you as a physician.

GROSS: What are some of the most typical health problems that astronauts who are spending time in space experience?

FONG: Well, you know, it's funny because when you see spacemen and women on television, you get this impression that it's sort of like a slightly more fun version of a super-long-haul passenger flight - that, you know, it's a quite comfortable experience, and they're just floating around there having quite a lot of fun while engaging in quite a serious task.

But when you look down into it, you realize that these expeditions are true expeditions - expeditions really in the same sense that walking into the desert or climbing our highest mountains or, you know, exploring our polar regions are - that, you know, you go into this environment, and it's the same - you learn the same lessons from it that you learn everywhere else in exploration. And that is that we can exist there but not forever and not without penalty.

And they experience everything from a wasting of their bones, wasting of their muscles, wasting really - de-conditioning of their heart because their heart itself is a muscle pump - all of this because of the lack of gravitational load, the lack of the force of gravity upon their bodies.

And then there's some stuff that you wouldn't really readily predict. They have problems with their hand-eye coordination. It seems that the apparatus in your inner ear that detects accelerations, that helps you with your day-to-day hand-eye coordination also gets pretty messed up up there. And so they have problems tracking moving objects with their eyes.

And also on top of that they feel pretty sick. And in fact, most rookie astronauts feel sick or are sick in the first 24 to 48 hours of flight. So when you see them up there on camera waving and smiling at you, you have to know that underneath that is a lot of discomfort for lots of them.

GROSS: So we've talked a little bit about, you know, studying medicine in space. But you've also worked with deep-sea diving medicine. And that puts a completely different set of pressures on the body, being underwater. What are some of those pressures?

FONG: Well, you know, when you look at the envelope that supports life around the Earth, it's remarkably thin. And when you're talking about diving, and if you put a tank of air on your back, if you get in the water and you dive maybe 10, 20, 30 meters down, you start to experience problems just with the effects of pressure on your body and what that does to the air that you're breathing.

And so, you know, at 30 meters depth, you can get drunk on the nitrogen in the air that you're breathing, which is really quite a remarkable thing - that a normally inert gas can play havoc with the way that your brain works, you know, even at that shallow depth of penetration into that sphere. So this is just, you know, this is close enough to the surface that you can see the surface above you rippling overhead. But it's changing you, and it's changing the things that you're doing.

In addition to that, you know, you get these gases dissolving in your bloodstream and so subtly changing your physiology, changing your biology so that you're adapting to this new environment, but at the same time you're storing up problems for when you return. And so for those people who are involved in, you know, recreational diving, we all know that you have to have this very strict time limit on how long you spend at depth. And you have to very carefully return to the surface gradually so that you don't - those bubbles of nitrogen don't just fizz out of solution and cause you problems, cause problems with decompression illness or things that we more commonly refer to as the bends and illnesses related to that.

And I've always thought it was quite remarkable that, you know, the layer that supports human life around the Earth is probably about - you know, breathing room air is probably about, you know, 10, 20 meters into the ocean, breathing air, and probably no more than about 9,000 meters if you're going up a mountain.

GROSS: You tell this great story of something that happened to you in your chapter about underwater medicine. And you were trained in escape training underwater. This is the Royal Navy's Helicopter Underwater Escape Training Facility. And the goal here was to teach you how to escape from a helicopter that has crashed in the ocean. You're submerged and you have to get out. And there's some amazing things about what happens to the body underwater and why everything that you have to do is totally counterintuitive if your helicopters crash. So can you talk about that negative buoyancy?

FONG: Yeah, so, you know, most of our experience of the water and all the ocean is limited to a couple - literally a couple of meters, you know, from the surface. And so we feel this sensation that the water wants to throw us back out. You know, it's hard. It takes effort to dive below the surface, doesn't it?

And very few of us really dive to any depth at which that relationship changes. But what happens is as you dive into the water, the water around you starts to compress the tissues of your body so that you yourself become more dense. And after you've gone maybe only - depending on your build and what you're wearing - but maybe seven, eight meters from the surface, so you know, a very modest distance. You are no longer buoyant. That is, you will no longer float. You're more likely to sink than float.

And so after that point, you become negatively buoyant, which is to say that you sink. And so the problem is if you're in a vehicle that has crashed or is sinking, and you are more than, you know, a few meters, a handful of meters under the surface, you're going to be more likely to sink than float.

And this causes huge problems if you're in a vehicle and there is no source of illumination, so if you're in there at night - and you have this horrific realization that if you find yourself below about 10 meters at night with no light to show you the way, you're not going to have an idea of which way to swim, and you're just going to have to choose a direction. And if you choose the wrong direction, you're going to swim for the rest of your life, quite literally.

GROSS: Yeah, 'cause you'll just be swimming deeper and deeper instead of up?

FONG: That's right, that's - so, you know, when you're in a swimming pool...

GROSS: Or just swimming to the side. I mean, I guess you wouldn't know up, down, left, right.

FONG: There is no side. You're in a vehicle that may have turned upside-down. It's very difficult to know what's up and what's down. You are - you know, when you're in a - our common experience of swimming is at very shallow depths. And when you're swimming around, you know, you feel that you want to be taken back to the surface. If you do nothing, mostly, you're going to find yourself back on the surface.

And that is not true after a very, very shallow excursion beyond those very modest steps. And suddenly you have a new respect for both, you know, these things that you're traveling in over water, the ocean itself, and you realize how hostile that is as an environment. And now, it's not there to support us. It's, you know, pretty inimical to human life, really. We're not supposed to be in it. We're only just about supposed to be on it.

GROSS: So you describe -you know, you're in a test facility, in basically a large warm pool, very large warm pool.

FONG: Yeah, it was at the time, yeah.

GROSS: And you're in this, like, submerged helicopter, learning how to escape. This is like a training experience for if this happens in the ocean.

FONG: In this training operation, they put you in this thing that looks pretty much exactly the sorts of helicopters that may take you from the shore to an oil rigger. And you're strapped in with a - in my case, I think it was a five-point harness. And then you go into the water.

And so the first thing that you think that you would do if you're in a vehicle that is sinking, and the water's pouring in the windows is, well, you'd unstrap from your seat, and you'd try and get out. But the problem with that is you've got such a current of water coming in through all the openings that if you do that, you're just going to get washed around inside this vehicle as the vehicle itself turns over and starts sinking.

And you're going to get disorientated. You're going to get lost inside this vehicle. You're probably never going to make it out because you'll never find your way to an exit. So counterintuitively, what you're supposed to do is to sit there and have the presence of mind to put your hand - one hand on the buckle of your seatbelt so you know how to undo that, and the other hand on an exit, preferably on the handle that's going to eject the window that you're going to swim out of.

And then you're meant to wait. And I think the phrase they use is to wait for all violent motion to cease, which is basically them saying wait until you're really sinking, and everything's stopped moving. And then once that happens, then you're meant to eject the window, hold onto the window frame and then pull your seat buckle apart and pull yourself out of the window.

It takes quite a lot of discipline to resist that urge just get the hell out of there from the word go, but that is, that becomes, the difference between life and death in that situation.

GROSS: How did your body and your mind fight each other when your body was saying, get me out of here, and your mind was saying, no, I have to sit still? I have to wait until it turns upside-down. I have to wait until I'm totally immersed in water.

FONG: Yeah, well, you know, it is completely - if no one had told you what to do, you would've done completely the opposite. You would've unbuckled from your belt the minute that you saw the water coming in the sides, and I think that would have been the end of you. I mean, they show you very graphically that that is not the right thing to do.

And so what you realize is that in those situations, your life depends on a sequence of fairly simple, massively counterintuitive steps that protect you from yourself, really, in that situation. And so the key to it is just listening to what your instructor is telling you and to believe, to have faith in them that that's the right thing to do.

And once you do that, once you get used to that, once you can overcome your overwhelming sort of panic response to think, well, surely the less time I'm in this vehicle the better, then everything's OK, and it's actually almost, almost calm. But they do show you - you know, they do show you beforehand - they show you videos of sort of these young, I guess they're young airmen from the Royal Air Force or from other branch of the armed services who haven't listened.

And the thing goes in, the thing goes upside-down. They unbuckle. They get lost, and they find themselves swimming around in the dark, unable to find their way out before an instructor hauls them out, you know, very heavily through the window. So you know you don't want to do that.

GROSS: So when you finally at that last minute pull the release and undo your safety belt, how do you know which way to swim?

FONG: Yeah, that's a great question. So, you know, if it's daylight, and there's still some light around, you know, you're supposed to watch for bubbles and watch the bubbles rising and follow the bubbles. If it's nighttime, you hope that it's a clear night, and you might see some illumination, you know, moonlight perhaps through the surface.

But, you know, it is possible that it is a deep, dark, black night, and you're swimming out into the inky blackness. And you just don't know, and you're just going to have to choose a direction. And there are accounts of these sort of - accounts from sailors with these terrifying stories of them swimming out into the inky blackness, not knowing, and swimming and swimming and just hoping that they've chosen the right way and hoping that it's going to take them up to the surface.

GROSS: I know among the many things that you do is you practice emergency anesthesia medicine in a helicopter trauma unit, which is where you were last week, flying around. Do you expect you'd ever need to use this emergency training?

FONG: Well, I hope not, but you know, I think a lot of the stuff I've done has given me a fairly healthy respect for things that I guess we take for granted and certainly respect for the physical environment around us. And helicopters are amazing vehicles, but they are quite fragile, and they are prone to accident. So you can't rule out the possibility that flying over water one day, you might have some catastrophic failure of the vehicle. So you've got to be prepared for that, I guess.

I mean, the vehicle that I fly in actually doesn't fly over great expanses of water, but you know, for anyone who travels in these vehicles, you know, and for anyone who's ever traveled in a helicopter, your - actually your first emotional response is usually one of excitement. But it should be, should be more rationally one of gentle trepidation.

You know, there's a lot of moving parts. There's a lot to go wrong. And sometimes it does. So you know, it's worth respecting that mode of transport.

BIANCULLI: Kevin Fong, speaking last year with Terry Gross. His book "Extreme Medicine" has just been published in paperback. We'll hear more of their conversation after a break. This is FRESH AIR.

This is FRESH AIR. Let's get back to our interview with Dr. Kevin Fong, author of the book "Extreme Medicine: How Exploration Transformed Medicine In The Twentieth Century." It's just come out in paperback.

(SOUNDBITE OF ARCHIVED BROADCAST)

GROSS: So among all the things that you do, you're an anesthesiologist. And you tell a very funny story about another anesthesiologist who was being interviewed for a position at a hospital and was asked, how do you see your job? Would you just tell us the punch line there because it's hysterical?

FONG: So it's funny - isn't it? - because, you know, our popular imaginings of anesthesiologists is, you know, they sort of sit at the end of the table and do what the surgeon tells them to do, and occasionally they sneak off and do the crossword when they're a bit bored, when in fact it's much more dynamic role than that.

And indeed, it's very challenging because you're sitting there trying to look after the patient's physiology and stop - you know, counteract the effects of the drugs they're using or the blood that the surgeon is releasing. And so a colleague of mine interviewed for a job with a cardiothoracic team - so a bunch of heart surgeons.

And in that interview, one of the slightly pompous heart surgeons says, listen, I want to know what you think you can contribute to this team, what you think you can contribute to this heart surgery. And my colleague sort of sat there and said, well, that's easy. It's like flying a plane. I fly the plane, and you provide the in-flight entertainment.

And I think that is pretty much the relationship we have with our surgical colleagues, I think.

GROSS: So in what sense is the anesthesiologist flying the plane?

FONG: Well, so I think, you know, anesthesia is a very subtle thing, really, because - you know, and it's a thing of great trust. The patient comes to you, and you wrest control of their physiology, their biology from them temporarily. You send them to sleep, and you take over much of the automatic function of their body -many of the things that the body usually controls by itself automatically. You are asked to come in and at least regulate and monitor and intervene on things like blood pressure and heart rates and even temperature. And so you are their - sort of the patient's advocate, if you like, protecting them, wrapping them in this sort of cocoon of protection that you build with the drugs that you have, your knowledge of the drugs and their effects on their body, and you resuscitate them.

And you know, in the biggest operations you are sitting there actively resuscitating the patient from the insult that is surgery. And don't get me wrong, the surgeons do a wonderful job, but that insult is necessary. But it's an insult nevertheless that they need to be protected from, and that's part of the anesthetist's role.

GROSS: Have you been under anesthesia?

FONG: I have, actually, yes. I had my appendix out, in fact, before I was a medical student. And it's funny, you know, looking back it later on and realizing what was going on because at the time I just had no idea. So yes, I've had anesthesia myself.

GROSS: Was it lucky that you didn't know? Would you be more uncomfortable now?

FONG: I don't know. I think it depends on who was giving me the anesthetic, actually.

GROSS: Right, and that's the thing. We don't know. Like. we choose our surgeon, we choose our doctor to the best of our abilities. Like. let's find the best surgeon to do this. But you don't hear many people saying, and let's find the best anesthesiologist. You just kind of take that for granted.

FONG: Yeah, I mean, you know, you're right to try and choose the best surgeon because the best surgeon with the best hands is probably going to give you the best chance. But, you know, it's gone past the point where surgery is really about the person with the best pair of hands and the best knife. These are real team sports.

You know, it's a little bit like watching, you know, a live band onstage. Yes, all eyes are on the lead singer, but, you know, you want to have a good bass guitarist and a good drummer in there somewhere. Otherwise, the whole thing's going to come apart. So, you know, we love inventing this narrative of the lone superhero, but actually, you know, I'm not sure that they really exist in modern medicine.

You know, what you should be looking at - the complexity and the performance of the team as a whole, in which the anesthesiologist is a very integral part.

BIANCULLI: Kevin Fong, speaking last year with Terry Gross. He's the co-founder of the Center for Altitude, Space and Extreme Environment Medicine at University College London, where he's also a professor of physiology. His book "Extreme Medicine" has just been published in paperback. He'll be back after a short break. And our film critic, David Edelstein, will review "Clouds Of Sils Maria," the new film starring Juliette Binoche and Kristen Stewart. I'm David Bianculli, and this is FRESH AIR.

This is FRESH AIR. I'm David Bianculli, sitting in for Terry Gross. Let's get back to Terry's interview with Dr. Kevin Fong, author of the book "Extreme Medicine." It explains what doctors have learned about how our bodies work and how to save lives through treating patients exposed to extreme cold, heat, trauma and the extreme conditions of outer space and the deep sea. Dr. Fong is the co-founder of the Center for Altitude, Space and Extreme Environment Medicine at the University College London, where he's also a professor of physiology. He's an anesthesiologist and is trained in intensive care medicine. Kevin Fong spoke with Terry last year when his book was published. It's just come out in paperback.

(SOUNDBITE OF ARCHIVED BROADCAST)

GROSS: One of the chapters in your new book is about what happens to the body in frigid - in just, like, extreme cold. So you juxtaposed two stories. One is the story of what happened to Robert Falcon Scott, an explorer who froze to death in Antarctica in 1912 with the survival of a 29-year-old woman who was under the ice in frozen water for 80 minutes before she was even rescued, and her heart had stopped beating. It's an incredible story. But let's just start...

FONG: Yeah, it truly is.

GROSS: Let's start in Antarctica. What happens to the body? What happened to Robert Falcon Scott's body when he froze to death?

FONG: So Falcon Scott's expedition - so in 1912, he takes his polar party of five men to the South Pole. And the reason that I was interested in that story was because, you know, it shows you how far we've come in a very short space of time. You know, at the start of the 20th century, the maps of the world still had white space, space where no human foot had ever trodden, and that included the South Polar Region and the summit of our highest mountain and our deepest oceans, let alone the endless skies. So Scott's out there in 1912, walking back from the South Pole, having failed to win the race to the Pole; that race has been won by the Norwegian team led by Roald Amundsen. And they run into trouble. They run into a huge storm. And he, with the remaining three surviving members of the expedition party, find themselves in a tent freezing to death.

So within each cell, nearly every single cell in our body are these little organelles called mitochondria, which are the powerhouses of the cell. They are the sources of power of our life, really. And they're like biological batteries. And they work very, very crudely by separating charge across membranes, really like an electrical battery does - you know, the sort you'd put in your flashlights at home. And so as the - as Scott gets colder and colder, those biological batteries start to run down. And he can no longer maintain this sort of disequilibrium with the environment around him. He can no longer be this blazing furnace of life. And so, you know, finally and inexorably, he becomes like the wasteland around him - just no more energetic than the physical landscape in which he is and freezes to death.

GROSS: Well, and another thing that's happening to the body as the body is freezing is that the blood vessels are constricting. Why are they constricting and what impact does that have on the body?

FONG: So just before you freeze to death, you mount this sort of, you know, final effort to try and save your life. And so you try and centralize the heat to the core of your body. Your blood vessels constrict to try and stop you losing, you know, heat from your periphery, from your arms and from your legs. And then you try and get your hairs to stand on end what you do it's one of the reflexes we have. So your hair stands on end trying to trap an extra layer of air to insulate your body - so to try and trap an extra layer of air close to your skin to insulate your body. But, you know, all of this is your body sort of mounting its last-ditch attempts to keep itself alive. It does everything it can. It shivers hard to try and generate extra heat. It, you know, get your hair standing out on end trying to trap that layer of heat.

But all of this is really, you know, in the supposition that you can do something to change your environment to stop this process continuing. It's to buy you a bit of extra time. But in the case of Scott in that tent in 1912, there is no time to be bought. There is no rescue. And so all of those efforts, all of those efforts to keep him alive are kind of in vain.

GROSS: So let's compare this to an incident in 1999 where a woman nearly froze to death and amazingly didn't. Two women and a man are skiing in Norway. A 29-year-old woman on the ski trail follows through the ice, ice over a stream. She falls into the freezing water. She's trapped there for 80 minutes until people come and pull her out. And then she first has to get to some kind of, you know, medical situation. Her heart had stopped beating. She didn't have a pulse. How is her body able to survive, considering in some - I mean can't you say she was technically dead?

FONG: Well, I mean, certainly, she was at the state at which she was she'd be indistinguishable, really, from someone who was dead. Her heart wasn't beating. She wasn't breathing. She was blue, cold and lifeless. And you would've had to look extraordinarily hard to find any, any signs that she was alive at all. But incredibly, despite the fact that her heart stopped for perhaps nearly three hours, she was resuscitated successfully. And this then is the story of Anna Bagenholm, who is a remarkable, remarkable woman.

So she was a junior doctor in 1999 - I think about 29 years old, with two of her friends skiing in the northern mountains of Norway, so up in the Arctic Circle. And I think it was one of the first days of eternal sunshine at the start of the Arctic summer. And she catches an edge on her ski, goes headlong into a hole in some ice covering a stream and into that water. And they take a long time to get her out of there. And they know - they know because all of them are doctors - they know what's at stake here. They know that she'll freeze to death if they leave her in that position, but there is no one around to help them. The ski patrol are over an hour over the other side of the mountain. The nearest helicopter rescue is over an hour away flying time. And by the time they get her out of that ice - and I've spoken to her boyfriend who's one of the party. You know, when they retrieve her from the ice, they said she's blue and she's lifeless. And at that point, they thought all they were going to achieve there was to retrieve the body of a dead friend. Nevertheless, they started to resuscitate her.

And they resuscitate her and continue resuscitating until the helicopter arrives. Now, the helicopter can't land, so it throws down a winch. And they take her aboard the helicopter. And this is maybe an hour after her heart has first stopped. On the helicopter now, they continue to resuscitate her, even though it's another hour's flight back to Tromso, which is the nearest major hospital in that region. And so when they arrived to through front doors of the hospital, her heart has not beaten for the best part of two hours, maybe two hours, actually. And that's - to a clinician, to a doctor, that's an incredible thing to hear - that you have someone who arrives, and you're being told that her heart had been beaten for, you know, maybe two hours. And that question that you ask is, is it worth us trying to resuscitate her here?

And, you know, in clinical practice for me, when that happens, when you're called to see someone who's in cardiac arrest, whose heart had stopped, almost the first thing you ask is well, how long? How long has it been? How long has it been since their heart stopped? And if someone tells you it's been more than about half an hour, you're pretty pessimistic about your chances of getting someone back alive. And yet for her, she's been down now for two hours and they still decide to proceed - which is, I don't know if heroic is the right word, but it's an incredible decision - that they're hoping. They have one last hope, and that is that the thing that has stopped her heart, the thing that is killing her, has also protected her, has protected her brain from the starvation of oxygen that it suffered. And they know that this is possible. They know that for people who come in at very low temperatures, there is a chance of resuscitating them, even after extended periods of time if they've been cold enough. Now...

GROSS: Why is that? Is the refrigeration of your body kind of keeping it fresh in a way, in a way that it would food?

FONG: So that's right. So the cold, the hypothermia is a double-edged sword here because it conspires to run the batteries of life down, really in a way. And that's what stops your heart. It's - you know, that's what leads to the cardiac arrest. But also it protects the brain. So although it kills you, it smears out the dying process. And death, you know - we think of death as being a moment in time. But actually, it is a process. And that process is usually, you know, relatively quick. It's completed in a few minutes under normal conditions. But here, with these extremes of cold, you know - and her core temperature is 13.7 degrees Celsius, I think, when she arrived. So, you know, our normal core body temperature now is 37 degrees, both of us. It's within plus or minus about .2 degrees of that. So her core temperature is incredibly low. And what that does, biologically, is it takes the process of death and it smears it out over seconds and extends it to minutes. And in her case, they hope that it has smeared out to be hours long - long enough that they might intervene, restore the supply of oxygen to her brain, start her heart again and get someone back who resembles the person she was before the accident.

GROSS: And they had to warm her blood and warm her body. Would you explain how they did that?

FONG: Yes. And, I mean, that's a fascinating part of the story, really because, you know, when we get someone into our ER rooms who needs resuscitating, you know, you stick them on the gurney and you get to work in the resuscitation base. But they had the presence of mind to know that that wasn't going to be enough. They knew that they needed to re-warm her very quickly if they were to have any chance. And so they took her past the ER, straight up to the operating theaters. And they plugged her into a heart-lung bypass machine - the sort of machine that you would use to do open-heart surgery. And they do that because they know that, you know, there's no point in sticking warmed blankets on top of her or giving her warmed fluids. That's not going to be enough.

They need to raise her whole body, you know, I guess 50- to 60-odd kilograms of body up through, you know, about 20 degrees Celsius of temperature. And to do that, they're going to have to remove the blood from her body with this bypass machine and warm it up outside the body inside this machine and then send that back into her body in the hope that that can resuscitate her. And so that's what they do - they do effectively. They do a bit of bypass surgery on her. They plug tubes into her great veins and her major arteries and re-circulate her blood out of her body into a machine that's capable of warming up very quickly. And three hours after her heart had first stopped, it begins to beat again for the first time.

GROSS: And after a very long period of several years' worth of, you know, slow recovery and physical rehab, she's skiing again and working at this hospital that saved her life.

FONG: She's truly remarkable. And I've come to know Anna quite well. And she feels it's her duty to tell this story because you know, there are many people who wouldn't have tried as hard in that situation. There are many people who would've given up much sooner than this team did and yet, they continued. And today you have a woman who's a fully qualified doctor who is out there, you know, doing her job.

BIANCULLI: Kevin Fong, speaking last year with Terry Gross. His book "Extreme Medicine" has just been published in paperback. He'll be back after a break. This is FRESH AIR.

This is FRESH AIR. Let's return to Terry's 2014 interview with Dr. Kevin Fong, author of the book "Extreme Medicine: How Exploration Transformed Medicine In The Twentieth Century." It's just come out in paperback.

GROSS: If you're just running us, my guest is Dr. Kevin Fong. He's the author of the new book "Extreme Medicine." Let's take a short break here and then we'll talk some more. This is FRESH AIR.

(SOUNDBITE OF ARCHIVED BROADCAST)

GROSS: Your new book is about extreme medicine. And you've practiced extreme medicine. You've studied extreme medicine. You teach extreme medicine. What's the most extreme medical problem you've been called on to treat?

FONG: Gosh. That's very difficult to know. There have been many, many, many cases over time that have changed the way I've looked at things or in which, you know, people have survived unexpectedly. I think there's one particular episode in the book that I write about of a young man who, you know, we really thought there was no chance that he could survive.

He'd come to us very, very sick. And at the point which I was called to see him, he'd had repeated cardiac arrests, and we'd had to defibrillate him - so shock his heart - over and over again just to keep him going. And we thought there was some surgical disaster going on in his abdomen, and so we called the surgeon. The surgeon said, well, look, you know, he's not going to survive. I don't think there's anything we can do here.

But he was so young we thought, well, we've got to try and do something. And all the time we're having these conversations here in the background, all you're hearing is the paddles charging up and someone delivering another shock. And every time they do that, you wonder whether or not the heart's going to restore to a rhythm that's compatible with life.

And so it was one of those days when I thought, you know, we're not going to win here, but we have to try as hard as we possibly can. You know, he was very young. He was a teenager. And we took him to theater. And I think that was the toughest run I've ever had, actually. You know, it got to the point where I wasn't even really that focused on the anesthetic because, you know, all I was doing was repeatedly resuscitating this patient, shocking them every couple of minutes.

You know, and it got to the point where it was the early hours of the morning, and the heart would run into an abnormal rhythm again. And I wouldn't even do that thing of telling the surgeon to stand clear very loudly and have everyone stand clear. I would just nod at the team. The team would nod at me. They'd step back from the table, and I'd shoot the shocks again.

But, you know, the surgeons found the problem. We snipped out this loop of bowel that had died and sewed the patient up. We got him back to the Intensive Care Unit, and we had a very rocky 24 hours. But things got better and better and better. And he walked out the hospital, you know, a couple of weeks later. And when you see that happen once, you kind of have the hope that you might see it happen again.

GROSS: Does that help get you through all the times when it doesn't happen and you lose the patient?

FONG: It makes a lot of it worth it. I think, you know, you need to be reminded at times that it is worth trying. You can develop this sort of nihilism. I think I did very early on in my career. I sort of developed a sort of bit of nihilism about the whole thing. You know, I did really wonder whether it was a ridiculous thing to be pouring this much resource into, you know, patients who were this sick.

And I did wonder that there might be better, easier fights to have where we might do more good with less resources. But, you know, that's kind of what the book is about for me. It's about the fact that the edges of medicine, at the limits of what we can do, we're still exploring. We're still exploring the human body and what medicine can do in the same way that the great explorers in the 20th century and every age before them explored the physical world.

And so I think in writing the book, I was able to reconcile these sort of disparate strands in my life. And, you know, I was quite pleased to have done so.

GROSS: Well, Dr. Kevin Fong, thank you so much for talking with us.

FONG: Thank you.

BIANCULLI: Kevin Fong, speaking last year with Terry Gross. His book "Extreme Medicine" has just been published in paperback. Dr. Fong is the co-founder of the Center for Altitude, Space and Extreme Environment Medicine at the University College London, where he's also a professor of physiology. Coming up, our film critic David Edelstein reviews "Clouds Of Sils Maria," the new film starring Kristen Stewart and Juilette Binoche. I'm David Bianculli, and this is FRESH AIR.

DAVID BIANCULLI, HOST: This is FRESH AIR. Kristen Stewart impressed the critics at last year's Cannes Film Festival for her supporting role in the new film "Clouds Of Sils Maria." Stewart plays the personal assistant to an aging movie star played by Juliette Binoche, who is about to appear in a play opposite an infamous young Hollywood actress. Film critic David Edelstein has this review.

DAVID EDELSTEIN, BYLINE: "Clouds Of Sils Maria" is a high-flown title for a film with many earthly pleasures. But it's that mix of high and earthly that makes the work of the writer/director Olivier Assayas so thrilling. The film is a hall of mirrors. It sounds convoluted in the telling, but it plays easily, like a dream. It centers on a middle-aged film star named Maria Enders, played by Juliette Binoche, and her personal assistant Valentine, played by Kristen Stewart.

In the first scene, they're on a train to Switzerland, where Maria will accept an award for the elderly writer, who, many years earlier, cast her in a play called "Maloja Snake" that became a film and made her a star. As the train winds in and out of the Alps, she and Valentine juggle calls from agents, organizers, executives, Maria's divorce lawyer. And then comes the news the playwright has died, and Maria is forced to face her past, present and future at the same instant.

A hotshot stage director wants to revive "Maloja Snake" with a key change. Maria had played Sigrid, personal assistant to an older woman named Helena, whom the young woman seduces and abandons with devastating consequences. Now the director wants Maria to play Helena to the Sigrid of the blistering 19-year-old superstar Jo-Ann Ellis, played by Chloe Grace Moretz. Maria's first - and for that matter second and third - reaction is she can't. She's Sigrid, she says, powerful, headstrong, free to make her own rules. She could never be the weak, trapped, aging Helena.

But Valentine, her assistant, says she must play Helena, that Helena is Sigrid 20 years on, shattered by the sudden realization of her age and loss of power. By playing Helena as an older Sigrid, says Valentine, Maria will recover the edge and innocence dulled by decades of empty love affairs, variable movies and acting against green screens in comic book blockbusters. In the actress's rented cottage in the breathtaking Swiss village of Sils Maria, Valentine fills Maria in on her young, perspective co-star.

(SOUNDBITE OF FILM, "CLOUDS OF SILS MARIA")

KRISTEN STEWART: (As Valentine) Jo-Ann Ellis's movie is opening up in Europe. She wants to meet you.

JULIETTE BINOCHE: (As Maria Enders) When?

STEWART: (As Valentine) Next week.

BINOCHE: (As Maria Enders) Where?

STEWART: (As Valentine) Wherever you want. She'll come here if you'd like.

BINOCHE: (As Maria Enders) Definitely not here.

STEWART: (As Valentine) Maybe I'll tell her to book the Waldhaus.

(SOUNDBITE OF POURING)

BINOCHE: (As Maria Enders) When is the movie opening?

STEWART: (As Valentine) It opened last week. Have you read a paper lately?

BINOCHE: (As Maria Enders) Oh, sorry, you want one?

STEWART: (As Valentine) It's playing in St. Moritz if you want to see it.

BINOCHE: (As Maria Enders) I'd rather wait until rehearsal's started, keep the image of Sigrid as my (inaudible) - I know, I know, it's disturbing. I found it more interesting.

STEWART: (As Valentine) I didn't know you at 18, but I'm almost positive Jo-Ann's a lot worse.

BINOCHE: (As Maria Enders) How can you be so sure?

STEWART: (As Valentine) Have you Googled her?

BINOCHE: (As Maria Enders) Well, I just looked at the pictures.

STEWART: (As Valentine) Well, you should dig a little deeper - won't take you long to find all the naked photos, the latest updates on her exploits.

EDELSTEIN: The first thing that hits you about "Clouds Of Sils Maria" is how deliciously meta it is. The characters in the play overlap with the characters in the film overlap with Juliette Binoche, Kristen Stewart and Chloe Grace Moretz. A big source of delight is watching Stewart, so famous in tabloids for her sullen, shlumpy affect, gulp coffee, field calls and run interference with the paparazzi while envisioning Stewart's own personal assistant doing the exact same thing. She is wonderful and unusually comfortable, ironically, by plumbing her own discomfort, using her squirmy, non-actressy presence to generate an amazing amount of sympathy.

Moretz arrives in the last 45 minutes and upstages everyone. Her Jo-Ann is just coming into her sexuality, a peak moment for an actress in this culture. The "All About Eve" side is strong and not just vis-a-vis the conflict on screen. Binoche is dwarfed on the international celebrity circuit by Stewart. But Stewart's era as a so-called franchise goddess ended with the last "Twilight" film. And now she's gazing on Moretz, the next generation's it girl.

Each actress is, in her own way, preternaturally high-strung, able to convey momentous emotional stakes without raising her voice. It's Binoche, though, who anchors "Clouds Of Sils Maria." Her Maria is in denial of her aging for much of the movie. But then, with such subtlety you can't see it happening, she transforms. She becomes more self-possessed, less a victim of time than a faintly amused bystander, feeling the first stirrings of something beyond the material world. In the end, you realize the director, Olivier Assayas, has used these ephemeral, gossip magazine ingredients - wealth, fashion, celebrity - as a springboard for that most timeless of themes - the ephemerality of us all.

BIANCULLI: David Edelstein is film critic for New York magazine. On the next FRESH AIR, we look back at a time in the 1970s when in one 18-month period, there were 2,500 bombings in the U.S. by radical underground groups. We talk with Brian Burrough about the Weathermen, the Black Liberation Army and others.

BRIAN BURROUGH: They believed a revolution was imminent and that violence would speed the change.

BIANCULLI: His new book is "Days Of Rage." Join us.

Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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